Severity Of Coronary Occlusion Research Articles

Cardiac magnetic resonance features associated with the risk of cardiac arrest in patients with acute myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This work was supported by the George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Research Grant number NR. 164 / 26 / 10.01.2023. Background Cardiac arrest (CA) is the most severe complication of acute myocardial infarction (AMI). The role of different factors related to the site and severity of coronary occlusion in the pathogenesis of AMI-related cardiac arrest is still under investigation. The aim of the study was to investigate the association between (1) different cardiac magnetic resonance (CMR) features associated with the location and severity of the myocardial injury, and (2) the risk of CA accompanying an AMI. Methods In total, 54 patients AMI undergoing post-AMI CMR imaging with delayed gadolinium enhancement were enrolled in the study. The study lot was divided into 2 groups: group 1–8 patients who survived a CA in the acute phase of AMI and group 2–46 patients, matched for age and gender, with AMI but without CA. In all patients, infarct mass, the proportion of high transmural extent, and scar mass at different myocardial segments were calculated using the QMap software (Medis BV). Results Compared to patients without CA, those with CA had a significantly higher infarct mass (47.9 +/- 38 g versus 23.3 g, p = 0.03), infarct mass % (26.9 +/ 17.3% vs 15.1 +/- 8.6 %, p = 0.02), and a higher degree of transmurality (29.28 +/- 20.2 % vs 14.1 +/- 9.2 %, p = 0.01). Location of myocardial injury at the level of latero-apical, anterolateral, and bazal anterior segments seemed to be more frequently associated with the risk of CA in the acute phase of AMI: infarct mass 33.9 +/- 30.6 g in group 1 vs 13.6 +/- 17.3 g in group 2, p = 0.02 for the latero-apical segment, 26.5 +/- 29.0 g in group 1 vs 8.9 +/- 12.8 g in group 2, p = 0.02 for the anterolateral segment, and 20.1 +/- 21.5 g in group 1 vs 7.8 +/- 14.7 g in group 2, p = 0.02 for anterobazal segment. Conclusions Myocardial mas, high transmural extent at CMR imaging, and a large myocardial injury identified by CMR at the level of the anterior and lateral ventricular segments seems to be associated with an increased risk of CA in the acute phase of AMI.

Cardiac Magnetic Resonance Features Associated with the Risk of Cardiac Arrest in Patients with Acute Myocardial Infarction

Abstract Background: Cardiac arrest (CA) is the most severe complication of acute myocardial infarction (AMI). Besides the location and severity of coronary occlusion, different factors may have significant role in the pathogenesis of AMI-related cardiac arrest (CA), but their contribution is still under investigation. The aim of the study was to investigate the cardiac magnetic resonance (CMR) features of myocardial injury associated with a higher risk of CA accompanying an AMI. Methods: In total, 918 myocardial segments from 54 post-AMI patients undergoing CMR imaging with delayed gadolinium enhancement were enrolled in the study, of which 18.54% presented CA during the acute phase of AMI. In all patients, infarct mass, the proportion of high transmurality extent, and scar mass at different myocardial segments were calculated using QMap software (Medis BV). Results: Compared to patients without CA, those with CA had a significantly higher infarct size (p = 0.03) and a higher degree of transmurality (29.28% vs. 14.1%, p = 0.01). The risk of CA during the acute phase was significantly higher in patients in whom the location of myocardial injury was at the level of latero-apical, antero-lateral, and basal anterior segments. Group 1 presented a larger infarct size at the level of the latero-apical (33.9 ± 30.6 g vs. 13.6 ± 17.3 g, p = 0.02), anterolateral (26.5 ± 29.0 g vs. 8.9 ± 12.8 g, p = 0.02), and anterobasal segment (20.1 ± 21.5 g vs. 7.8 ± 14.7 g, p = 0.02). Conclusions: CMR imaging identified infarct mass, high transmurality degree, and large myocardial injury as features associated with an increased risk of CA in the acute phase of AMI, especially at the level of anterolateral segments.

Combining Stress Speckle Tracking with High-Sensitivity C-Reactive Protein in Diagnosis of Coronary Artery Disease.

Introduction: CAD (coronary artery disease) is a leading cause of death and disability in developed nations. Exercise testing is recommended as a first-line diagnostic test for patients with stable angina pectoris. In addition to myocardial strain, high-sensitivity CRP (hs-CRP) can predict the presence of significant coronary artery disease. Aim of work: The purpose of this study was to demonstrate the utility of 2D-speckle tracking at rest and under stress along with hs-CRP for detection of CAD in patients who were referred to the chest pain unit with stable or low risk unstable angina pectoris. Methods: A total of 108 individuals met the inclusion criteria and gave their written consent to participate in this study. Coronary angiography was performed within 48 h after admission to the chest pain unit. Myocardial strain was recorded at rest and during dobutamine administration. Results: Global longitudinal strain at stress appeared to be moderately correlated with the presence of significant coronary artery disease (CAD); r = 0.41, p < 0.0001. A moderate correlation was also found between global longitudinal strain at stress and the severity of coronary occlusion; r = 0.62, p < 0.0001. With a cut-off value of −19.1, global longitudinal strain under stress had a sensitivity of 74.1% and a specificity of 76.7% for detecting significant CAD. Hs-CRP was significantly higher in patients with manifested CAD. Conclusion: Evaluation of longitudinal strain parameters at rest and under stress may predict coronary artery disease in patients with stable angina pectoris. A measurable Hs-CRP is a potential marker of coronary stenosis. Strain data could assist in diagnosing CAD severity.

The expression level of microRNA-122 in patients with type 2 diabetes mellitus in correlation with risk and severity of coronary artery disease

BackgroundType 2 diabetes mellitus (T2DM) has reached epidemic proportions worldwide. Coronary artery disease (CAD) is one of the most important causes of mortality worldwide. MicroRNAs (miRNAs) modulate gene expression and is involved in the pathogenesis of T2DM and CAD. The objective of the current study was to explore the expression pattern of miR-122 in T2DM with or without CAD. Moreover, we aimed to evaluate the association between miR-122 and risk and severity of CAD in T2DM.Participants and methodsThis cross-sectional controlled study enrolled 130 patients with T2DM and 110 control group. The enrolled diabetic patients were classified into two groups: seventy patients without CAD and 60 patients without CAD. All patients were investigated using a 12-lead standard ECG, echocardiography, and coronary arteriography. The serum MiR-122 expression profile was measured using quantitative real-time (qRT) PCR.ResultsmiRNA-122 expression levels were significantly higher in T2DM, in particular patients with T2DM with CAD, compared with the control group. Interestingly, miRNA-122 expression levels were positively correlated with cardiometabolic risks and severity of coronary occlusion. Linear regression analysis test showed that miRNA-122 were independently correlated with high-density lipoprotein, ejection fraction, and uric acid. The power of miRNA-122 expression level to diagnose T2DM among studied participants was evaluated using receiver operating characteristic. The area under curve was 0.997 (95% confidence interval=0.993–1.00), with sensitivity of 96.9% and specificity of 99%, and regarding the power for differentiating patients with T2DM with CAD from patients with T2DM without CAD, the area under curve was 0.832 (95% confidence interval=0.763–0.902), with sensitivity of 93.3% and specificity of 96.86%.ConclusionThe miRNA-122 expression levels were higher in the T2DM group compared with controls, in particular patients with CAD. The higher levels of miR-122 expression were strongly correlated with cardiometabolic risk factors and severity of coronary occlusion. Therefore, miR-122 expression levels seem to be a noninvasive biomarker for CAD.

Serum salusin-\u03b2 levels as predictors of coronary artery disease in obese Egyptian women

EnBackgroundObesity is a growing health concern that has become an epidemic all over the world. Obesity is associated with coronary artery disease (CAD). Salusin-β is an endogenous bioactive peptide that accelerates inflammatory responses in vascular endothelial cells and increases oxidative stress. The objective of this study was to explore the potential roles of salusin-β in endothelial dysfunction in CAD. Also, we aimed to evaluate the association between salusin-β with severity of CAD in obese Egyptian women.Patients and methodsThis cross-sectional study enrolled 95 obese women who were classified into two groups: 58 patients without CAD and 37 patients without CAD. All patients were investigated using a 12-lead standard ECG, echocardiography, and coronary arteriography. Salusin-β levels were measured by enzyme-linked immunosorbent assay.ResultsSalusin-β levels were significantly higher in obese patients with CAD compared with patients without CAD. Salusin-β levels were positively correlated with cardiometabolic risks and severity of coronary occlusion. Serum salusin-β levels, high-sensitivity C-reactive protein, and BMI were independently correlated with CAD and BMI. Homeostatic model assessment of insulin resistance, high-sensitivity C-reactive protein, and uric acid were the main associated variables of serum salusin-β levels among other clinical and laboratory biomarkers. The diagnostic power of serum salusin-β levels in differentiating CAD from obese patients without CAD was highly sensitive (97.2%) and the specificity was 98.3%.ConclusionThe higher levels of salusin-β levels in obesity, as well as CAD, were positively correlated with cardiometabolic risk factors and severity of coronary occlusion. Therefore, salusin-β levels seem to be a noninvasive biomarker of CAD.

Human coronary heart disease: importance of blood cellular miR-2909 RNomics

The characterization of atherosclerosis as a chronic inflammatory disease has triggered extensive research worldwide to dissect the pro- and anti-inflammatory, cellular as well as molecular mechanisms governing the pathogenesis of this dreadful disease. Though several microRNAs have been shown to play crucial role in regulating lipid metabolism and inflammation, we are far from resolving the role of epigenomic signals in etiology of coronary heart disease (CHD). The present study was addressed to understand the role of a novel microRNA, miR-2909, in the regulation of genes involved in the initiation and progression of human coronary occlusion. Peripheral blood mononuclear cells were isolated from human CHD subjects at various stages of coronary occlusion (n=80) and their corresponding normal healthy counterparts (n=20). Various experimental strategies involving gene expression and silencing, reporter plasmid assays, and flow cytometric analysis were blend together to address the current problem. The present study shows for the first time that the blood cellular miR-2909 expression increases with the severity of coronary occlusion, exhibiting a strong positive correlation (r=0.943 at p<0.01). Further, miR-2909 was shown to regulate genes involved in inflammation, immunity, and oxLDL uptake, thereby contributing significantly to the initiation and progression of CHD patho-physiological process. Based upon these results, we propose that miR-2909 RNomics may be a step forward in understanding human CHD at the epigenomic level and can be exploited for designing new therapeutic strategies as well as diagnostic and prognostic markers for this disease in future.

Functional genomics of blood cellular LXR-α gene in human coronary heart disease

Recent studies on the liver X receptor-α (LXR-α) have recognized its crucial protective role in the initiation of a cross-talk between lipid metabolism and inflammation regarded as a prerequisite for the development of atherosclerotic lesions. The present study was directed to explore the functional genomics of LXR-α gene within blood mononuclear cells of subjects suffering from coronary heart disease (CHD), revealed a paradoxical relationship between blood cellular LXR-α mRNA expression and the severity of coronary occlusion. In order to resolve this apparent paradox, the ligand binding domain of LXR-α gene was analyzed. The results of such a study revealed that three critical mutations in the domain comprising of amino acids Asp324, Pro327 and Arg328, were responsible for inability of this domain to interact with its natural ligands leading thereby to deregulation of its effector genes that are known to play crucial role in the cross-talk between lipid peroxidation and inflammation. This phenomenon was in conformity with functional assay of LXR-α dependent transcriptional activity within cells derived from normal and CHD subjects. Based upon these results we propose that the mutations in the LXR-α gene reported here for the first time not only may be exploited for the diagnosis of CHD in human subjects but also could be used as a marker for exploring the predisposition of human subjects towards CHD.

21 Urokinase-type plasminogen activator (u-PA) and the risk of coronary events in patients with angina pectoris (AP)

Introduction. This study addresses the rote of circulatory u-PA in the prevention and precipitation of arterial thrombosis. u-PA occurs in three forms: the inactive zymogen scu-PA, the active enzyme tcu-PA and u-PA#, the inactive complex of tcu-PA with inhibitors. In apparently healthy individuals (n=50) scu-PA amounts 2.2±0.4 ng/ml, u-PA# 1.1 ±0.8 ng/ml and the concentration of tcu-PA is neglectable. Methods. 3043 AP patients from all over Europe (ECAT AP Study) were followed for two years for the occurrence of coronary events. Blood collection and angiographie assessment of the severity of the disease (VESS, the number of more than 50% occluded coronary vessels of the patient) were performed on admission. u-PA analysis was performed centrally, on 2410 patients. Total u-PA Ag was measured by ELISA. scu-PA by BIA. and u-PA# was calculated as the difference between the two. Statistics: ANOVA, multiple regression analysis; partial correlation coefficients p are provided. Results. AP patients have on average a lower scu-PA ( 1.9±0.5 ng/ml) and a higher u-PA# level ( 1.6±0.6 ng/ml) than healthy individuals (P<0.001 ). The scu-PA level varies significantly between medical centres in Europe (range of means 1.3 - 2.3 ng/ml, 14 centres, P<0.001), and is negatively correlated (p = -0.32, P<0.001) with the event rate of the centres, which ranges from 1.5 to 7.0 events per 100 patients. By comparison, LDL cholesterol is positively correlated with the event rate (p = 0.13, P<0.001 ) and u-PA# is not correlated. However, scu-PA, and also LDL chol, are not correlated with the risk of an event as such, but with VESS, the severity of coronary occlusion (scu-PA negatively: p = -0.08, P= 0.001 ; LDL chol positively: p = 0.16, P<0.001 ). The risk of an event is correlated with u-PA# and VESS, both positively, without any association between the two (u-PA#: p = 0.10, P= 0.004; VESS: p = 0.13, P<0.001 ). The effects of a scries of known risk factors are subordinate to those of u-PA# and VESS, and are annihilated in competition therewith. The risk of an event in the highest u-PA# quintile relative to the lowest is 2.6, and the standardized relative risk is 1.5. For VESS these figures amount 5.1 and 1.8, respectively. Discussion: scu-PA is negatively correlated with the severity of coronary occlusion of the patients and with the event rate of the centres. We propose that the subnormal blood scu-PA levels, which are indicative of an impaired fibrinolytic potency and a resulting intensified thrombotic tendency, are of causative importance in the long-term evolution of AP. u-PA# is a novel risk marker, which is not associated with the severity of coronary occlusion. We suggest that the supernormal blood u-PA# levels reflect another aspect of the severity of the patient's condition, such as vascular resistance.

Expressive vocal behavior and the severity of coronary artery disease.

This study sought to ascertain the relationship of expressive vocal behavior in a structured interview and the severity of coronary artery disease in a group of 79 patients referred for coronary angiography. One half of the structured interview was administered in a nonchallenging manner, the other half in a moderately challenging manner. In patients age 60 and younger, two speech measures derived from the nonchallenging interview, a computer-scored index of the frequency of simultaneous speech and judged loudness level, accounted for 38% of the variance in the patients' severity of stenosis scores, when the latter was indexed by the Gensini method. The same speech indices derived from the challenging interview segment accounted for only 18% of the variance on the patients' Gensini scores. In the older patient group, only one speech variable, speech rate in the nonchallenging interview segment, contributed to the patients' Gensini scores. The findings suggest a) that in younger patients objective, computer-scorable, speech variables correlate significantly with severity of coronary occlusion, and b) that is not essential that these speech indices be derived from a structured interview that is administered in a challenging and provocative manner. In the present study, there were no significant correlations between the participants' global TABP scores and their occlusion scores.